Rates for Primary Care Services

Congress has adjourned session for 2014 without having taken any action to extend enhanced reimbursement for eligible primary care services. Therefore, enhanced reimbursement will end on December 31, 2014. Because Congress has not extended the Primary Care Services Enhanced Payment Program for services in 2015, the AHCCCS Administration will not accept attestations submitted after December 31, 2014. If Congress takes any action in January 2015 or later to extend federal funding, AHCCCS will comply.

AHCCCS continues to monitor whether Congress will authorize continued federal funding for
enhanced reimbursement for eligible primary care services for dates of service on and after
January 1, 2015. To date, no such funding has been allocated. Should Congress not approve the
enhanced payments for 2015 in the next few months, AHCCCS will discontinue the enhanced
reimbursement for eligible primary care services for dates of service beginning January 1, 2015.

Congress has occasionally authorized expenditures that take effect retroactively.
In the event that Congress approves the enhanced federal funding for eligible primary care
services after January 1, 2015, AHCCCS will notify providers and MCO’s of the process for
obtaining such reimbursement.

The web-based Provider attestation form is available. The link can be found under
Provider Attestation Information below.

Overview

Section 1202 of the Affordable Care Act requires that Medicaid reimburse designated
primary care providers who provide primary care services and vaccine administration
services at rates that are not less than the Medicare fee schedule in effect for
2013 and 2014, or, if greater, at the payment rates that would result from applying
the 2009 Medicare physician fee schedule conversion factor to the 2013 or 2014 Medicare
payment rates. These reimbursement requirements apply to payments made between January
1, 2013 to December 31, 2014.

Federal Interface

Almost 6 months after issuing proposed rules, on November 6, 2012, the Centers for
Medicare and Medicaid Services (CMS) published final rules effective January 1,
2013 that set forth the requirements for State Medicaid Agencies mandated by Section
1202 of the ACA. In response to the many comments to the proposed rules that outlined
unaddressed operational questions, burdensome requirements, and the limited time
period to comply with the federal provisions prior to the January 1, 2013 implementation
date, CMS has authorized States until March 31, 2013 to submit their methodologies
to CMS for approval. The final rules clarify that approvals of timely State submissions
will be retroactive to January 1, 2013.

On July 18, 2013 those providers who received a request to submit a copy of their board certification, the deadline for
submission has been extended to July 31, 2013. Refer to the PCP page for more information.

On July 2, 2013, CMS approved AHCCCS' financial methodologies. AHCCCS anticipates that enhanced
payments for qualifying claims by qualifying providers with dates of service on or after
January 1, 2013 will not begin until after August 1, 2013, but will be made retroactively to
January 1, 2013 or the individual provider attestation date if attestation was made on or after 5/1/2013.

On June 27, 2013, AHCCCS submitted Managed Care Organization (MCO) contract amendments
to CMS. As noted in the CMS approval letter dated 7/2/13, this requirement is the final
step for Federal approval to implement the primary care increase. AHCCCS anticipates
written approval of these amendments by July 31, 2013, and further anticipates implementation
of the rate increases on August 1, 2013.

AHCCCS recognizes the significant impact and burden that the federal delay and new
federal requirements will place on providers in order to obtain the new funding.
AHCCCS and its contracted health plans will follow the procedures, processes and
policies that are being developed by the federal government. Although these requirements
are mandated by the federal government, AHCCCS apologizes for the increased burden
this will place on providers and requests that providers be patient as the agency
works through the many challenging issues that result from these new requirements.
Please continue to check the webpage for updates on this issue.